Beyond the Bump: Nurturing Your Mental Health During Pregnancy and Postpartum

This blog was written in partnership with Chun-Li Kok, PT, DPT.

Pregnancy and the postpartum period are often painted as times of excitement and joy but they are also periods of immense change – physical, emotional, hormonal, and social. Beneath the glow of expectant parents is also the reality of other challenges that are not talked about as much. 

It's time to break the silence and shed light on the importance of nurturing your mental well-being during this transformative phase of life. Because supporting a new life starts with supporting your life.

The Unseen Burden: Mental Health in Pregnancy

Individuals are at an increased risk for mental health symptoms during the perinatal period which starts during pregnancy. Even before your baby arrives, hormonal fluctuations can lead to mood swings, anxiety, irritability, and depressed mood. Societal expectations, body image concerns, relationship changes with spouse and current children, and worries about childbirth and parenthood can all impact your mental health. 

Why are perinatal mental health conditions often missed? Many attribute these emotional changes to "just pregnancy hormones" or the natural stress of impending parenthood. But dismissing these symptoms can prolong suffering and negatively impact parents and the developing baby.

The Fourth Trimester: A Landscape of Mental Vulnerability

The perinatal period extends throughout the first year postpartum and parents remain particularly vulnerable to mental health concerns during this time. The emotional rollercoaster continues once the baby arrives. Postpartum recovery, sleep deprivation, and the overwhelming demands of newborn care can all impact emotional wellness. Parents who experience pregnancy and infant loss are also at risk of experiencing mental health concerns during this timeframe. 

So what’s normal and what isn’t? Around 80% of new parents experience “Baby Blues.” The Baby Blues typically begin within 3 days postpartum and can last up to 2 weeks. Symptoms of Baby Blues can include tearfulness, mood swings, irritability, reactivity, anxiety, and fatigue. Baby Blues and general discomfort are normal when adjusting to life with a newborn. However, some parents experience more significant mental health challenges and benefit from additional support. It is important to contact your doctor, nurse, midwife, or pediatrician if you or your partner’s symptoms don’t subside after 2 weeks or if you notice any signs or symptoms of perinatal mood and anxiety disorders. Medical providers can provide appropriate screening and referrals for mental health treatment, if necessary. 

Common Perinatal Mood and Anxiety Disorders (PMADs)

PMADs can affect birthing and non-birthing parents, including adoptive parents. Studies show that 1 in every 5-7 women and 1 in every 10 men meet criteria for PMADs during the perinatal period. 

Perinatal Depression (formerly Postpartum Depression)

Perinatal Depression affects about 15% of women and between 2-25% of men. Symptoms usually begin 1-3 weeks postpartum but can present at any time during the perinatal period. Symptoms of perinatal depression include sadness, hopelessness, decreased interest in activities, emotional distress, irritability, low self-esteem, guilt, tearfulness, poor concentration, isolating from others, sleeping too much or too little, changes in appetite, fatigue, difficulty caring for the baby, thoughts of suicide, and/or thoughts of harming the baby. 

Perinatal Anxiety

Perinatal Anxiety affects about 6% of pregnant women and 10% of postpartum women. Between 4-16% of men also experience perinatal anxiety. Symptoms of perinatal anxiety include uncontrollable anxiety or worry, racing thoughts, catastrophic thinking, irritability, feeling on edge, obsessive thoughts, fearfulness, asking for constant reassurance, excessive caution with the baby, excessive checking on the baby, overly controlling behaviors, forgetfulness, fidgeting, feeling unable to relax, avoiding people or activities, difficulty sleeping, muscle tension, dizziness, nausea, excessive sweating, chest tightness, and/or loss of appetite. 

Perinatal Obsessive-Compulsive Disorder (OCD)

Perinatal Obsessive-Compulsive Disorder (OCD) affects roughly 3-5% of women. Perinatal OCD is a specific type of perinatal anxiety disorder. The hallmark symptom of perinatal OCD involves intrusive, upsetting, persistent, repetitive thoughts or mental images related to the baby. These thoughts are usually upsetting or disturbing to the parent and cause a great deal of anxiety. 

Perinatal Post-Traumatic Stress Disorder (PTSD)

Perinatal Post-Traumatic Stress Disorder (PTSD) affects approximately 3% of parents. Perinatal PTSD often results from trauma experienced during delivery such as a prolapsed cord, unplanned c-section, use of vacuum extractor or forceps during delivery, newborn admitted to the NICU, injury related to childbirth, and feelings of powerlessness during childbirth. Symptoms of perinatal PTSD include intrusive thoughts, nightmares, and anxiety related to a traumatic event. 

Why It's Important to Talk About It

1. It's Not Your Fault: Experiencing mental health challenges during this time is not a sign of weakness or a reflection of your parenting ability. It's a medical condition, often triggered by a complex interplay of hormones and life changes.
2. Early Intervention Matters: The sooner you recognize and address these issues, the better the outcome for both you and your baby. Untreated maternal mental health conditions can impact infant development, attachment, and the overall family dynamic.
3. You're Not Alone: Sharing your experience can help others feel less isolated and empower them to seek help.
4. There's Hope and Help: Effective treatments are available, including therapy, medication, support groups, and lifestyle adjustments.

An Integrated Approach: The Link Between Physical Recovery and Mental Well-being

While we've focused heavily on the direct mental health challenges, it's vital to recognize that our physical body and mental state are intrinsically linked. The physical changes and recovery period of pregnancy and postpartum can profoundly impact mental well-being, often contributing to feelings of anxiety, frustration, isolation, and even depression.

Beyond the common knowledge of pelvic floor exercises for incontinence, pelvic floor physical therapy (PFPT) offers a holistic approach to recovery:

• Addressing Physical Pain and Discomfort: Lingering pain from childbirth (perineal tears, episiotomy, C-section recovery), pelvic girdle pain, hip pain, or urinary/fecal incontinence can be incredibly debilitating. When you're constantly in pain or worried about an accidental leak, it impacts your ability to engage with your baby, enjoy social outings, or even just feel comfortable in your own skin. Pelvic floor PT can alleviate these physical symptoms, reducing a significant source of stress and mental burden.
• Restoring Body Confidence and Control: Issues like diastasis recti (abdominal separation), prolapse (when pelvic organs descend), or sexual pain can leave individuals feeling disconnected from their bodies, undermining self-esteem and body image. Pelvic floor PT helps restore core strength, pelvic floor function, and addresses these specific concerns, empowering individuals to regain control and rebuild confidence in their physical capabilities. This renewed sense of body autonomy can be incredibly uplifting mentally.
• Improving Sexual Health and Intimacy: Sexual pain or fear of intimacy postpartum is a common but rarely discussed issue that can strain relationships and impact mental well-being. Pelvic floor PTs can address these physical barriers. 
• Facilitating Movement and Exercise: For many, returning to exercise is a key part of feeling like themselves again. However, doing so without proper pelvic floor and core rehabilitation can sometimes lead to injury or worsen existing issues. Pelvic floor PTs can help guide a safe and effective return to activity, ensuring that movement becomes a source of joy and energy, rather than further physical or mental stress.

In essence, PFPT is not just about strengthening muscles; it's about helping you heal physically so you can heal emotionally and mentally. It's a fundamental piece of the postpartum recovery that directly contributes to a parent's overall sense of well-being, confidence, and capacity to engage fully with their new role.

Nurturing Your Mental and Physical Well-being: Practical Strategies

• Build Your Support System: Lean on partners, family, friends, and other new parents. Don't be afraid to ask for help with childcare, meals, or household chores.
• Move Your Body: Gentle exercise, like walking or prenatal yoga, can boost your mood and energy. A pelvic floor PT is a great place to start with a pelvic floor screen and resource for safe exercises postpartum. 
• Practice Mindfulness and Relaxation: Deep breathing exercises, meditation, or simply taking a few moments of quiet can help manage anxiety.
• Connect with Other Parents: Sharing experiences with those going through similar changes can be incredibly validating and supportive.
• Set Realistic Expectations: Parenthood isn't always picture-perfect. Allow yourself grace and understand that some days will be harder than others.
• Don't Suffer in Silence: Seek Professional Help.

When to Seek Professional Help

• Your symptoms are severe or persistent.
• You're having trouble functioning daily.
• You're struggling to bond with your baby.
• You have thoughts of harming yourself or your baby.
• You feel overwhelmed, hopeless, or empty.

How to Reach Out for Help

• If you are in crisis or if you have safety concerns related to your mental health:
  • Visit the nearest emergency department (ED) for immediate care
  • Call the National Suicide and Crisis Lifeline: 988
  • Call the Maternal Mental Health Hotline: 833-852-6262
• Contact your healthcare provider (PCP, OB/GYN, Midwife, Pediatrician, etc.) for further screening and referrals to mental health providers, if needed. 
• For additional support and referrals to care
  • Contact the Postpartum Support International (PSI) Helpline: 1-800-944-4773
  • Contact the CHI Health Behavioral Health Information and Referral Line: 402-717-HOPE (4673)

The Takeaway

Pregnancy and postpartum are profound journeys that deserve holistic support – including mental health support. By normalizing the conversation, offering resources, and encouraging open communication, we can empower expectant and new parents to prioritize their mental well-being and thrive during this incredible, yet challenging, chapter of life.